MEDICARE: CHILD & ADULT REHAB SERV INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	01538	MD

General Provider Information

NPI Number	:	1215101399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD & ADULT REHAB SERV INC

Provider Business Mailing Address
First Line	:	85 HIGH STREET
Second Line	:	SUITE 7
City	:	WALDORF
State	:	MD
Zip	:	20602-2150
Country	:	US
Telephone Number	:	301-645-6540
Fax Number	:	301-934-8302

Provider Business Practice Location Address
First Line	:	85 HIGH STREET
Second Line	:	SUITE 7
City	:	WALDORF
State	:	MD
Zip	:	20602-2150
Country	:	US
Telephone Number	:	301-645-6540
Fax Number	:	301-934-8302

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	MRS. LOIS ELIZABETH KONDAS
Credential	:	MA CCC SP
Telephone Number	:	301-645-6540

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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Directions to “CHILD & ADULT REHAB SERV INC ” Practice Location

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